Would Adding Residency Slots Solve the Primary-Care Shortage?

ByJacob Goldstein

With the medical establishment warning of a looming shortage of primary-care docs and general surgeons, Sen. Chuck Schumer is getting ready to introduce an amendment to the Senate health-care bill that would add 2,000 new medical residency slots, the WSJ reports this morning. But adding residency slots may not be enough to guarantee enough primary-care doctors and general surgeons.

Medical residencies, the clinical training programs docs go through after med school, are a key driver of physician supply in America. And since residencies are funded through Medicare, the federal government is a key player in determining doctor supply.

But doctors who go through residencies in fields such as surgery and internal medicine often choose do further training in a sub-specialty, rather than practice as general surgeons or primary-care internists. They do so, in large part, because many sub-specialties have higher pay, higher status and, in some cases, better hours. Adding more residency slots won’t change that.

In family medicine, another key supplier of primary-care docs, there isn’t even enough interest among qualified young docs to fill existing residency slots. Hundreds of slots went unfilled this year, and graduates of foreign med schools filled many of the available positions.

What’s more, doctors finishing up their residencies tend to gravitate to places where there are already lots of other doctors, not to places where physicians are scarce.

Still, there are other provisions of the health-care legislation that could encourage more young doctors to go into primary care and to move to the places docs tend to be scarce. As the WSJ notes, the Senate bill increases funding for the National Health Service Corps, which helps repay student loans for docs and other providers who work in underserved areas. Primary-care doctors who participate can get up to $50,000 of loans repaid.

Image: iStockphoto

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